MILITARY MEDICINE, Vol. 177, January 2012
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MILITARY MEDICINE, 177, 1:27, 2012
Research has found veterans are at increased risk for home-
lessness compared to the general population, 1,2 particularly
among veterans who have served in the all-volunteer force,
which began effectively in 1975 following the Vietnam War. 3–5
In response, the U.S. Department of Veterans Affairs (VA)
has implemented and developed a large array of health care
initiatives to provide specialized services for these veterans. 6
Although VA has created its own homeless programs and has
made a commitment to ending homeless among veterans in the
coming years, 7 many veterans either do not have access to VA
services or choose to use non-VA community services. 3,8–10
There has been little study of veterans in non-VA home-
less programs 11 and few comparisons with non-veterans who
are homeless. Past studies have generally found that homeless
veterans are older, more likely to be white, better educated,
and have greater substance abuse problems than other home-
less men, 12,13 although a few studies have found that homeless
veterans seeking residential treatment are a younger, more
educated, and higher functioning subgroup than general vet-
eran and non-veteran homeless groups. 14 However, it is not
clear whether veterans remain at increased risk for homeless-
ness compared to non-veterans once they are engaged in treat-
ment in non-VA community programs, even when they are
encouraged to use VA services.
The current observational study compared veterans and
non-veterans in a national-supported housing initiative for
chronically homeless adults initiated jointly by the U.S. Depart-
ment of Housing and Urban Development, the Department
of Health and Human Services, and the VA. Comparisons
address individual characteristics at the time of program entry
and whether veterans were at increased risk for homelessness
and poor clinical outcomes during treatment, after accounting
for baseline characteristics.
Data were obtained from the Collaborative Initiative to Help
End Chronic Homelessness (CICH). 15 CICH was implemented
in 2004 by the U.S. Interagency Council on Homeless to pro-
vide adults who were chronically homeless with permanent
housing and supportive primary health care and mental health
services at 11 sites in the United States. The criterion for eli-
gibility was chronic homelessness, defi ned as “an unaccompa-
nied homeless individual with a disabling condition who has
either been continuously homeless for 1 year or more or has had
at least four episodes of homelessness in the past 3 years.” The
11 communities funded through CICH included Chattanooga,
Tennessee; Chicago, Illinois; Columbus, Ohio; Denver,
Colorado; Fort Lauderdale, Florida; Los Angeles, California;
Martinez, California; New York, New York; Philadelphia,
Pennsylvania; Portland, Oregon; and San Francisco, California.
Each site developed a comprehensive plan, which included
strategies for providing permanent housing, linking compre-
hensive supports with housing, increasing the use of main-
stream services, integrating system and services, and ensuring
its sustainability. Efforts were made when clinically appropri-
ate to connect veterans with VA services and VA clinical staff
worked within each program.
A total of 756 participants gave informed consent to par-
ticipate in the national evaluation of CICH. The mean num-
ber of participants at each site was 69, ranging from 52 to 98.
Homeless adults were recruited by clinical and research staff at
Do Homeless Veterans Have the Same Needs and
Outcomes as Non-Veterans?
Jack Tsai , PhD * † ; Alvin S. Mares , PhD ‡ ; Robert A. Rosenheck , MD * † §
ABSTRACT Although veterans have been found to be at increased risk for homelessness as compared to non-veterans,
it is not clear whether those who are homeless have more severe health problems or poorer outcomes in community-based
supported housing. This observational study compared 162 chronically homeless veterans to 388 non-veterans enrolled
in a national-supported housing initiative over a 1-year period. Results showed that veterans tended to be older, were
more likely to be in the Vietnam era age group, to be male, and were more likely to have completed high school than
other chronically homeless adults. There were no differences between veterans and non-veterans on housing or clinical
status at baseline or at follow-up, but both groups showed signifi cant improvement over time. These fi ndings suggest that
the greater risk of homelessness among veterans does not translate into more severe problems or treatment outcomes.
Supported housing programs are similarly effective for veterans and non-veterans.
* VA New England Mental Illness Research, Education, and Clinical
Center, 950 Campbell Avenue, 151D, West Haven, CT 06516 .
† Department of Psychiatry, Yale University, 300 George Street, New
Haven, CT 06511.
‡ College of Social Work, The Ohio State University, 1947 College Road,
Columbus, OH 43210 .
§ School of Epidemiology and Public Health, Yale University, 60 College
Street, PO Box 208034, New Haven, CT 06520.
The views presented here are those of the authors, alone, and do not repre-
sent the position of any federal agency or of the U.S. Government.